Article

Gait adaptability, including the ability to avoid obstacles and to
take visually guided steps, is essential for safe movement through a cluttered
world. This aspect of walking ability is important for regaining independent
mobility but is difficult to assess in clinical practice. The
objective of this study was to investigate the validity of an instrumented
treadmill with obstacles and stepping targets projected on the belt's surface for
assessing prosthetic gait adaptability. This was an observational study.
METHODS: A control group of people who were able bodied (n=12) and groups of
people with transtibial (n=12) and transfemoral (n=12) amputations participated.
Participants walked at a self-selected speed on an instrumented treadmill with
projected visual obstacles and stepping targets. Gait adaptability was evaluated
in terms of anticipatory and reactive obstacle avoidance performance (for
obstacles presented 4 steps and 1 step ahead, respectively) and accuracy of
stepping on regular and irregular patterns of stepping targets. In addition,
several clinical tests were administered, including timed walking tests and
reports of incidence of falls and fear of falling. RESULTS: Obstacle avoidance
performance and stepping accuracy were significantly lower in the groups with
amputations than in the control group. Anticipatory obstacle avoidance
performance was moderately correlated with timed walking test scores. Reactive
obstacle avoidance performance and stepping accuracy performance were not related
to timed walking tests. Gait adaptability scores did not differ in groups
stratified by incidence of falls or fear of falling. LIMITATIONS: Because gait
adaptability was affected by walking speed, differences in self-selected walking
speed may have diminished differences in gait adaptability between groups.
CONCLUSIONS: Gait adaptability can be validly assessed by use of an instrumented
treadmill with a projected visual context. When walking speed is taken into
account, this assessment provides unique, quantitative information about walking
ability in people with a lower-limb amputation.

Langue : ANGLAIS